Heat produced within a root canal during use of an ultrasonic instrument can be conducted through the dentin into periodontal ligament, bone and soft tissue. If severe in intensity or long in duration, it can induce damage to these tissues. This report describes a case in which an ultrasonic endodontic instrument apparently induced severe damage to alveolar bone, gingiva and nasal mucosa in a 42-year-old female. Overheating of a maxillary central incisor caused necrosis of soft tissue and bone on the facial and mesial aspects and triggered a protracted inflammatory response in the adjacent nasal cavity. To relieve the severe discomfort associated with this damage, the patient chose to have her maxillary incisors extracted and replaced by a removable partial denture. A defect in the soft tissue and bone was present at a follow-up visit 10 months after the extractions. While morbidity of this nature is rare, this case reinforces the need to maintain adequate cooling of ultrasonic instruments.